RESUMO
Nifurtimox (NF) is one of the only two drugs currently available for Chagas disease (ChD) treatment. However, data on NF safety are scarce, and many physicians defer or refuse NF treatment because of concerns about drug tolerance. In a retrospective study of adverse drug reactions (ADRs) associated with NF treatment of ChD, children received NF doses of 10 to 15 mg/kg/day for 60 to 90 days, and adults received 8 to 10 mg/kg/day for 30 days. A total of 215 children (median age, 2.6 years; range, 0 to 17 years) and 105 adults (median age, 34 years; range, 18 to 57 years) were enrolled. Overall, 127/320 (39.7%) patients developed ADRs, with an incidence of 64/105 adults and 63/215 children (odds ratio [OR] = 3.7; 95% confidence interval [CI], 2.2 to 6.3). We observed 215 ADRs, 131 in adults (median, 2 events/patient; interquartile range for the 25th to 75th percentiles [IQR25-75], 1 to 3) and 84 in children (median, 1 event/patient; IQR25-75 = 1 to 1.5) (Padjusted < 0.001). ADRs were mainly mild and moderate. Severe ADRs were infrequent (1.2% in children and 0.9% in adults). Nutritional, central nervous, and digestive systems were the most frequently affected, without differences between groups. Treatment was discontinued in 31/320 (9.7%) patients without differences between groups. However, ADR-related discontinuations occurred more frequently in adults than in children (OR = 5.5, 95% CI = 1.5 to 24). Our study supports the safety of NF for ChD treatment. Delaying NF treatment due to safety concerns does not seem to be supported by the evidence. (This study has been registered in ClinicalTrials.gov under identifier NCT04274101.).
Assuntos
Doença de Chagas , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Adulto , Doença de Chagas/tratamento farmacológico , Criança , Pré-Escolar , Tolerância a Medicamentos , Humanos , Nifurtimox/efeitos adversos , Estudos RetrospectivosRESUMO
OBJECTIVE: To examine the differences in the adverse drug reaction (ADR) profile of antipsychotic and antidepressant agents between pediatric and adult patients in studies submitted to the Food and Drug Administration (FDA) during the drug development process. STUDY DESIGN: Clinical trials in adult and pediatric patients were conducted by sponsors as part of the drug development programs for antipsychotic and antidepressant agents, and ADR information was collected as part of those trials and submitted to the FDA. Data collection was conducted by reviewing publicly available FDA-authored reviews and FDA-approved product labels for 10 drugs with an antipsychotic or an antidepressant indication from 2007 to 2017. RESULTS: There were 308 drug and ADR combinations for the 10 drugs and drug combinations with 113 (36.7%) having a significantly different incidence in pediatric patients compared with adults. Sixty-eight (60.2%) of these ADRs had a significantly higher incidence in pediatric patients than in adults. Sedation was higher in 6 of the 10 drugs and drug combinations with risk differences ranging from 9.6 to 36.6%. CONCLUSIONS: This analysis indicates that there were significant differences between the pediatric and adult safety profiles of antipsychotic and antidepressant drugs. Sedation was the major ADR associated with the use of atypical antipsychotic drugs in pediatric patients. Clinicians caring for children should consider the ADR profile when prescribing antipsychotics and antidepressants in pediatric patients.
Assuntos
Antidepressivos/efeitos adversos , Antipsicóticos/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Segurança do Paciente , Adolescente , Adulto , Criança , Ensaios Clínicos como Assunto , Humanos , Incidência , Pediatria , Risco , Estados Unidos , United States Food and Drug AdministrationRESUMO
Con el objetivo de destacar la importancia de la farmaco vigilancia en pediatría, se efectuó una revisión con especial énfasis en sus aspectos generales y conceptuales, sustentados en la Norma Oficial Mexicana y otras. Se describen las diferentes clasificaciones de las Reacciones Adversas a los Medicamentos (RAM) y de los Eventos Adversos a los Medicamentos (EAM). Utilizando como fuente la base de datos del Centro de Monitoreo Internacional de los Medicamentos, en la que se analiza hasta el año 2006 el estado actual de los reportes de las RAM de 82 países, en el que México se ubica, por grupos de edad y por número de reportes, en un lugar intermedio con el resto de los países. Se destaca el impacto de las RAM en la población general en aspectos de morbilidad, mortalidad, secuelas y economía. Se comunican las experiencias de grupos internacionales sobre el impacto de los EAM y las RAM en la edad pediátrica y neonatal. Se mencionan varias recomendaciones que permitirán que en México se implante o mejore un sistema de farmacovigilancia en los niños, en el que el Hospital Infantil de México Federico Gómez ha iniciado un ambicioso programa.
In order to emphasize the importance of pharmacovigilance in children, a review was carried out with special emphasis on general and conceptual aspects outlined in the Mexican Official Norm and other documents. The different classifications from the Adverse Drug Reactions (ADR) and Adverse Drug Events (ADE) are discussed. Using the data base of the WHO Collabotatory Center for Drugs International Monitoring, uppsala Monitoring Center (Sweden) we analyzed up to the year 2006 the present status of the ADR reports from 82 countries. Mexico ranks in the middle classified by age groups and number of reports in the data base. The impact of ADR stands out in the general population according to morbidity, mortality, sequealaes and cost considerations. The impact of ADE and ADR in new-borns and pediatric patients reports the experiences of international groups. Several recommendations are mentioned that will allow a system of pharmacovigilance to be established or improved for children in Mexico. The Hospital Infantil of Mexico has initiated an ambitious program.